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Purpose Tranexamic acid (TXA) is useful for reducing blood loss and blood transfusion after THA is useful for both intravenous (IV) and tropical routes. There is no distinction between DVT and VTE complications. There is currently no report of intraosseous tranexamic acid (IO-TXA) administration in THA. Methods A prospective, randomized, controlled study of 48 cementless total hip arthroplasty. 25 hips received TXA 750 mg intravenous route (IV-TXA) combined with 500 mg of TXA to the medullary canal, compared with 23 hips controlled by TXA 750 mg IV injection. The primary outcome is total blood loss (TBL) which is calculated using the Hemoglobin balance equation from hemoglobin. The secondary outcome is blood transfusion, which refers to IO-TXA's effectiveness, and complication regarding to IO-TXA's safety. Results THA patients who received combined IV and IO-TXA had ( 723.9 ± 233.5vs 1044.1 ± 425.7)of the control group (P = 0.03) ). However, there are no statistically significant differences in blood transfusion in the combined group 7/20 (28%) vs 9/18 (39%) in the IV-TXA group (P = 0.128), the complication was seen in only one case of Deep vein thrombosis (DVT) that received combined IV and IO-TXA. Discussion TXA frequency use in THA for reducing blood loss and blood transfusion, meta-analysis study comparison of combined IV and topical administration of TXA with IV-TXA alone show statistical different of Total blood loss(250.37, P = 0.000), no difference of hidden blood loss(117.23, P = 0.091), combined TXA can also decrease the transfusion rate by 9.1%(RR = 0.32; 95% CI: 0.17 to 0.63; P = 0.001). No significant differences were seen in DVT between the two groups (P > 0.05). Conclusion There is a statistically significant difference in TBL. Howerver, blood transfusions and complications are not statistically significant in combined IV and IO-TXA or IV-TXA.

Abstraction Background Total knee arthroplasty (TKA) was the procedure which is preform by orthopedic surgeons in end stage osteoarthritis knee patients who fail conservative treatment. Periarticular analgesia is one of the effective and safe technique used to reduce pain after surgery. However, the location and formula of the mixture have not yet been controversy. Recently, there were study comparing intraosseous analgesic injection which provide significant postoperative pain relief than control group. So the authors conducted this study to compare between periarticular and intraosseous analgesic injection in simultaneous bilateral total knee arthroplasty patients. Method The study is a two-arm, double-blinded,randomised controlled trial with Twenty-six patients(52 knees)who undergone simultaneous bilateral total knee arthroplasty.Primary outcome is post operative pain at 12 hour ,24hour and 48 hour by using Visual analog scale for assessment. Secondary outcome are postoperative range of motion at 24 and 48 hour, post operative blood loss and post operative complication. Discussion While periarticular analgesic is the standard practice .intraosseous analgesic injection is potential route for control post operative pain after total knee arthroplasty surgery. This study can offer better alternative route for analgesic injection.

Purpose:comparative the outcome of proximal femoral bone density change in follow-up x-ray film and proximal filling ratio of stem between anatomical and double taper wedge cementless stem design Methods: post-operative follow film of up to 1 year of patients who had undergone Total hip arthroplasty between 2552 -2563, which is match inclusion criteria, was obtained from the radiology department. The measurement of Canal filling ratio ( Lesser trochanter, 2 cm above LT and 7 cm below LT ) and Femoral bone density change using optimal densitometry method to compare between Anatomical and double wedge taper stem type. Result: 92 patients,76% female, and 24% male, were match the inclusion criteria for this study. The mean age was 53.86 ± 13.00 years old. The canal filling ratio in the double wedge taper group (Accolade II ) was significantly higher than the anatomical stem group ( ABGII ) (p<0.001, p<0.001, p=0.013) in all levels of measurement. There were no significant differences between both types of the stem in femoral bone density change in zone 1,4. However. There were significant differences in femoral bone change, in which bone loss was higher in the anatomical stem group, in zone 7 (-25 VS -17, P= 0.010) Conclusion: Double taper wedge stem design had a significantly higher canal filling ratio than the Anatomical stem at all levels and less femoral bone density loss in follow-up post-operative film at Zone 7. However, in zone 1,4, There was no significant difference in femoral bone density loss.

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